<?php
    /*Copyright (C) 2010  Marcelo Acosta - Cerrudo Walter

    This program is free software: you can redistribute it and/or modify
    it under the terms of the GNU General Public License as published by
    the Free Software Foundation, either version 3 of the License, or
    (at your option) any later version.

    This program is distributed in the hope that it will be useful,
    but WITHOUT ANY WARRANTY; without even the implied warranty of
    MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
    GNU General Public License for more details.

    You should have received a copy of the GNU General Public License
    along with this program.  If not, see <http://www.gnu.org/licenses/>.
*/
echo '
<div id="containerdatpers">

<h1><a id="logo" href="">Wufoo</a></h1>

<form class="wufoo" action="" method="">

	<div class="info">
	<h2>Datos de Usuario</h2>
	</div>

	<ul>
    	<li class="section first">
		<h3>Cuenta de Usuario</h3>
		<div></div>
	</li>
    <li class="complex">
  <div>
  
  <span class="full">
    <input name="txtUsuario" type="text" class="field text addr" id="txtUsuario" value="" />
    <label>
      <blockquote>
        <p>Usuario</p>
      </blockquote>
    </label>
    </span>
     </div>
     </li>
    
<li class="complex">
  <div>
  
  <span class="left">
    <input name="txtContrasenia1" type="text" class="field text addr" id="txtContrasenia1" value="" />
    <label>
      <blockquote>
        <p>Contrase&ntilde;a</p>
      </blockquote>
    </label>
    </span>
    
    <span class="right">
      <input name="txtContrasenia2" type="text" class="field text addr" id="txtContrasenia2" value="" />
      <label>Repetir Contrase&ntilde;a</label>
      </span>
     </div>
     </li>
<li class="complex">
  <div>      
      <span class="left">
        <select name="lstTipoUsuario" class="field select addr" id="lstTipoUsuario">
          <option value="-" selected="selected"></option>
          <option value="Administrador">Administrador</option>
          <option value="Usuario">Usuario</option>
        </select>
        <label>Tipo de Usuario</label>
        </span>
</div>
</li>

		<li class="section">
		<h3>Login de Datos Personales</h3>
		<div></div>
	</li>
    
<li class="complex">
  <div>      
      <span class="left">
        <select name="lstTipoDoc" class="field select addr" id="lstTipoDoc">
          <option value="France" selected="selected"> </option>
          <option value="DNI">DNI</option>
          <option value="LC">LC</option>
        </select>
        <label>Tipo:</label>
        </span>
        <span class="right">
      <input name="txtNroDoc" type="text" class="field text addr" id="txtNroDoc" value="" />
     Documento
     <label></label>
      </span>
        
  </div>
</li>
<li class="complex">
  <div><span class="left">
    <input name="txtNombre" type="text" class="field text addr" id="txtNombre" value="" />
    <label>Nombre</label>
    </span>
    
    <span class="right">
      <input name="txtApellido" type="text" class="field text addr" id="txtApellido" value="" />
      <label>Apellido</label>
      </span>
     </div>
     </li>
<li class="complex">
  <div>      
      <span class="left">
        <select name="lstSexo" class="field select addr" id="lstSexo">
          <option value="S" selected="selected"></option>
          <option value="M">Masculino</option>
          <option value="F">Femenino</option>
        </select>
        <label>Sexo</label>
        </span>
        <span class="right">
      <input name="txtFechaNac" type="text" class="field text addr" id="txtFechaNac" value="" />
     Fecha de Nacimiento
     <label></label>
      </span>
        
  </div>
</li>


	<li class="complex">
	  <label class="desc"></label>
	  <div>
	    <span class="full">
	      <input name="txtDireccion" type="text" class="field text addr" id="txtDireccion" value="" />
	      Direcci&oacute;n
	      <label></label>
	      </span><span class="left">
	      <input name="txtLocalidad" type="text" class="field text addr" id="txtLocalidad" value="" />
	     Localidad
	     <label></label>
	      </span>
	    
	    <span class="right">
	      <input name="txtProvincia" type="text" class="field text addr" id="txtProvincia" value="" />
	      <label>Provincia</label>
	      </span></div>
	  </li>



	<li class="complex">
    <label class="desc">Nacionalidad</label>
		<div>
		<span><input id="choice1" name="opcNac" class="field radio" type="radio" value="Argentina" checked="checked" />
		<label class="choice" for="choice1">Argentina</label></span>

		<span><input name="opcNac" type="radio" class="field radio" id="choice2" value="Otra"/>
		<label class="choice" for="choice2">Otra</label></span>
		</div>
    </li>
	<li class="section">
		<h3>Informaci&oacute;n de Contacto</h3>
		<div></div>
	</li>
<li class="complex">

  <div> 
  			<span class="left">
		<input name="txtTel" type="text" class="field text addr" id="txtTel" value="" />
		<label>Tel&eacute;fono</label>
		</span>

		<span class="right">
		<input name="txtCel" type="text" class="field text addr" id="txtCel" value="" />
		<label>Tel&eacute;fono M&oacute;vil</label>
		</span>
        
        <span class="full">
		<input name="txtEmail" type="text" class="field text addr" id="txtEmail" value="" />
		<label>E-mail</label>
		</span>
   </div>

	<li class="buttons">
		<input name="btnEnviar" type="submit" class="btTxt" id="saveForm" value="Enviar" />
	    <input name="btnBorrar" type="reset" class="btTxt" id="saveForm2" value="Borrar" />
	</li>
	</ul>

</form>

</div><!--container-->
';
?>